Clarification

The Congressional candidates speaking on the last day of the VRHA Conference will be incumbent Representative Morgan Griffith (R-9), and challenger Derek Kitts. We apologize for the confusion in last week's announcement.

You Are the Key to HPV Cancer Prevention

This breakout session will address the importance of HPV immunization as an effective prevention measure against HPV related cancers. Following a brief presentation with objectives of understanding the facts about HPV immunization, appropriate recommendations and guidelines for HPV immunization, and current VA immunization rates, participants will have the opportunity to discuss concerns, challenges and strategies to increase HPV immunization rates in rural Virginia.

Static on the Line

By John Hall - McKights

Some may find it laughable that in 2016, at high tide in the “Internet of Things,” an American nursing home on the edges of frontier lands does a great deal of communicating by fax machine with the outside world. Others may be similarly shaking their heads to learn one rural visiting nurse association put a trailer with a wireless access point on the side of the road so that nurses can sync their mobile phone apps while traveling. Or that one rural community's sole broadband internet service provider abruptly closed its doors, leaving everyone there without service for a month.

For 22 years, Dan Holdhusen has devoted seemingly every waking minute feverishly sparring with a partisan Federal Communications Commission board while trying to convince stubborn lawmakers to right a 62-year-old wrong: the exclusion of skilled nursing facilities from tapping into a big pot of federal money called the Universal Service Fund (USF). (Every business and American citizen who gets a phone bill in the mail will find a variously named line item collecting taxes to keep the USF fed.)

SPECIAL NOTE:On October 18th, VRHA will be hosting a kick-off meeting for the Virginia Rural Health Telecommunications Consortium. VRHTC will assist rural providers in drawing down the USF monies to improve their internet connections. Click here for more information.

Data Gap

By Laura Goren - Commonwealth Institute

Virginia is feeling the consequences of not closing the health coverage gap. While neighboring states such as West Virginia and Kentucky are making big progress, 746,000 Virginians still lack health insurance, which means they can’t get the care they need to go to work, take care of their kids, and be healthy, productive members of their community, according to 2015 Census data released today. If Virginia had seen as large a drop in uninsured residents as in the typical state that expanded Medicaid, there would be 170,000 fewer Virginians without health insurance.

Although Virginia is not keeping up with its neighboring states that have expanded Medicaid, the state does have 244,000 fewer uninsured residents than in 2013, the last year before the major coverage expansions of the Affordable Care Act. Hundreds of thousands of Virginians have gained coverage through the health insurance marketplace, which allows people to easily compare prices and benefits of health care plans and provides subsidies to help moderate-income families and individuals afford coverage.

Those subsidies, however, are not available to lower-income families and individuals. That’s because the Affordable Care Act included an expansion of Medicaid to provide comprehensive, low-cost coverage for the most vulnerable families. And many low-wage workers have no other option, since they are less likely than higher-wage workers to be offered insurance by their employers. But the U.S. Supreme Court in 2012 made that expansion optional, and the refusal so far by Virginia legislators to draw down federal funds to expand Medicaid continues to leave 230,000 Virginians in the coverage gap.

Children's Asthma

By Dan Heyman - Public News Service

Many Virginia kids spend their days gasping for breath, according to a new report. But new limits on pollution from oil and gas wells could help. A first-of-its-kind analysis from the Clean Air Task Force shows air pollution from oil and gas facilities impacting the folks downwind.

Janice Nolen, assistant vice-president for national policy with the American Lung Association explains more than nine million tons of methane and other pollutants are released each year by the industry, contributing to ozone and smog.

The report ties an estimated 24,000 Virginia childhood asthma attacks a year to oil and gas production. The Obama administration recently finalized rules on new sources of methane and ozone pollution from the oil and gas industry, and supporters say that should help.

FAMIS Anniversary

From the Office of the Governor

Governor Terry McAuliffe joined Dr. Rosa Atkins, the Superintendent of Charlottesville Public Schools; [VRHA member] Dr. Karen Rheuban, a Pediatric Cardiologist at University of Virginia and a member of the American Academy of Pediatrics; and Deborah Oswalt, Executive Director of the Virginia Health Care Foundation to celebrate the fifteenth anniversary of the Family Access to Medical Insurance Security program (FAMIS) in Virginia. FAMIS, Virginia’s Children’s Health Insurance Program (CHIP) provides quality, low-cost health insurance to children and teenagers of working families across the Commonwealth.

“We are celebrating an important milestone in the Commonwealth’s history, as FAMIS has provided more than 630,000 children in Virginia with health insurance over the past fifteen years,” said Governor McAuliffe, speaking at today’s event. “Since 2001, the Virginia Department of Education and local schools across Virginia have been the cornerstones for our FAMIS outreach efforts, ensuring parents know about the program and helping families enroll their children. The program’s success is attributed to the hard work of all the state and local agencies, as well as the medical community in Virginia. We will continue to make sure our children across the Commonwealth have access to quality, affordable health care options so that they can reach their full potential in the new Virginia economy.”

Since 2001 over 630,000 children have received health insurance through the FAMIS program. FAMIS also helps enroll thousands of children into the children’s Medicaid program, FAMIS Plus. Together, these two programs have provided critical health insurance coverage to more than 1.6 million Virginia children over the past fifteen years.

Quitting Obamacare

By Sarah Frostenson - Vox

The exit of large insurance plans from the Affordable Care Act marketplaces is likely to hit rural areas of the country the hardest. A new Vox analysis shows that the number of rural counties on the Healthcare.gov marketplace with just one insurer will nearly quadruple between 2016 and 2017. In 2016, 7.8 percent of rural counties reported one insurer available. But in 2017, that number is expected to rise to 30.7 percent.

Rural areas of the country have long struggled to attract insurance plans. The small populations and low concentration of doctors and hospitals makes it difficult for them to compete. The marketplaces initially seemed like they might be able solve that problem, giving insurance plans a new online platform where they could more easily reach individual consumers. But now, with some insurers exiting, there are questions about how much Obamacare can actually do to spur competition in areas of the country that are already underserved by the health care system.

“It’s tough in these rural markets, because it’s not like these rural markets were really competitive to begin with before ACA,” said Michael Dickstein, an economist at New York University who has studied insurers’ participation in the health law’s rural markets.

The EHR Struggle

By Sheri Stoltenberg - Health IT Analytics

Rural and small hospitals often face a lack of resources, limited budgets and competition from larger healthcare organizations and accountable care organizations. These organizations also endure pressure to electronically modernize services for patient communities who otherwise would have to travel extensively to receive care.

Though electronic health record (EHR) adoption is at an all-time high across the country, rural health and small community hospitals still lag behind in adoption and clinical optimization - particularly concerning interoperability between systems. For example, in 2015 the ONC found that small, rural and critical access hospitals (CAHs) were only half as far along as larger hospitals in four domains of interoperability measurement: electronically sending, receiving, finding and integrating patient health information.

A Good Dentist is Hard to Find

Jessica Stefonik is grinning. She's got a bounce in her step. Her cheeks are a little puffy and her speech is a bit thick. What she's trying to get used to is the feeling of having teeth.

On the day we met, Stefonik, a mom of three from Mosinee, Wis., got a set of dentures to replace all of her upper teeth, which she lost over many years to disease and decay. Stefonik is just 31 years old. She's one of millions of people who are poor and live in rural America and have little to no access to dental care.

A study by the Federal Reserve found that a quarter of Americans went without dental care they needed in 2014 because they couldn't afford it. For those in rural areas, the problem is far worse. A 2015 report by the Pew Charitable Trusts found that people in rural areas are poorer and less likely to have dental insurance than their urban counterparts. They're also less likely to have fluoridated water, and more likely to live in an area where dentists are in short supply. Those dentists that are there probably don't take Medicaid, government health insurance for the poor.

Looking Ahead: Rural-Urban Differences in Anticipated Need for Aging-Related Assistance
As the U.S. population ages, more adults will require assistance with activities of daily living. However, a person's beliefs and expectations about future needs and how these needs will be met may vary between rural and urban pre-retirement aged adults. This project analyzed nationally representative data from the 2011 and 2012 National Health Interview Survey to ascertain how rural and urban adults aged 40–64 view their future needs and coping.

Does ACA Insurance Coverage Expansion Improve the Financial Performance of Rural Hospitals?
The implementation of the Patient Protection and Affordable Care Act (ACA) increased access to health insurance coverage for previously uninsured or under-insured populations. Since rural residents are more likely than urban residents to be uninsured, increased access to health insurance should, in theory, provide a new source of revenue for rural hospitals and, therefore, improve financial performance. To better understand how the ACA’s expansion of insurance coverage has affected uncompensated care, unreimbursed cost, and financial performance in rural hospitals, the NC Rural Health Research Program interviewed rural hospital administrators, state hospital associations, and State Offices of Rural Health (SORHs).

Colonoscopy Access and Utilization – Rural Disparities in the Carolinas, 2001-2010
Colorectal cancer is the third most common cancer among U.S. men and women, and the second leading cause of cancer death for both sexes combined. Colorectal cancer screening is recommended in persons of average risk starting at 50 years of age. Due to advances in screening, the incidence and death rate from colorectal cancer has been decreasing in recent decades. Unfortunately, the successes observed on an aggregate scale do not hold true for all population groups, in part due to disparities in screening utilization. This study aims to explore differences in colorectal cancer testing rates and travel patterns between rural and urban residents of North and South Carolina between 2001 and 2010. Using population-based colonoscopy utilization data from outpatient discharge records, the research team has quantified travel patterns (particularly bypass behavior) for seeking care, and the availability of colonoscopy centers in rural counties.

Vulnerable Rural Counties: The Changing Landscape, 2000-2010
Our overall findings suggest that rural America experienced the recession that ended the 2000–2010 decade more severely than did urban America. Loss of income, declining population and reduced health care resources marked the period for most rural counties. Rural counties will need continued monitoring in the present decade to ascertain whether these adverse trends continue and to identify any policy approaches that can serve to ameliorate losses in health care services.

Hospital closures and the current healthcare climate
The impacts of hospital closures are harsh, affecting not only the patients that depend on them but also the economy in rural areas. We discuss recent healthcare reforms that have put rural hospitals at risk of closure, and the steps that these hospitals may take to ensure their sustainability into the future.

Graduates of Rural-centric Family Medicine Residencies: Determinants of Rural and Urban Practice
We surveyed graduates of family medicine residencies with a mission to produce rural physicians to understand physician characteristics, experiences, and attitudes that affected their practice location choices. Influential factors included partner or spouse characteristics, residency experiences, and practice community amenities. Some physicians are clearly self-selected into rural practice, but much needs to be done, particularly during and after residency training, to sustain their interests and to encourage other physicians to embark on rural careers.

Rural Medicare Advantage Market Dynamics and Quality: Historical Context and Current Implications
Quality ratings of Medicare Advantage (MA) plans were linked to MA payment in an attempt to incentivize quality improvement, beginning in 2012. There is significant variation in the quality ratings of MA plans that are available to rural beneficiaries. Historical factors tend to influence the quality star ratings of MA plans, including the age of the contract and the historical HMO penetration rate. In addition, plans entering and exiting the MA program can have an impact on average star ratings, as plans exiting the program typically have lower scores than new plans entering the MA market. This analysis indicates that the limited availability of high-scoring MA options in rural areas is likely impacting the enrollment of rural MA beneficiaries into high quality plans, as fewer rural beneficiaries than urban beneficiaries are enrolled in plans with high quality ratings. Overall, MA quality scores have been increasing since 2012; however, average quality scores of plans in rural areas continue to lag behind those in urban areas, possibly due to the historical factors and MA market dynamics since these differ in rural and urban places. Targeted adjustments may need to be made to MA plan payment to encourage MA plans operating in rural areas to achieve similar quality ratings to those in urban areas or to encourage high-quality MA plans to expand their service areas in rural markets.

Rural-Urban Differences in Insurer Participation for Marketplace-Based Coverage
The Patient Protection and Affordable Care Act of 2010 (ACA) creates organized Marketplaces through which subsidized private insurance can be purchased by individuals who lack access to public or affordable employer coverage. Insurers’ decisions to offer Marketplace plans in local markets (e.g., counties) have direct implications for the number and types of plans offered and premiums. The study described in this policy brief aimed to identify differences between rural and urban counties in the number of Federally Facilitated Marketplace (FFM) insurers available to consumers and examine variation in the composition of insurers serving counties, focusing on group affiliation (e.g., Blue Cross Blue Shield, UnitedHealthCare, Humana, Cigna, Aetna) and ownership status.

2015 National Healthcare Quality and Disparities Report
How Does Your State Measure Up in State Quality Rankings? The Agency for Healthcare Research and Quality (AHRQ) has updated their interactive tool which provides state-specific data on healthcare access and quality from AHRQ's 2015 National Healthcare Quality and Disparities Report.

Virginia Grants Portal
A one-stop resource that compiles and regularly updates these often hard to find opportunities. Includes local, state, federal, and private grant opportunities. Virginia Grants also offers important resources for navigating the complex grants-application process.

Veterans Transportation Service Locations
Designed to ensure that all qualifying Veterans have access to care through convenient, safe, and reliable transportation. VTS provides qualifying Veterans with free transportation services to and/or from participating VA medical centers (VAMCs) in a multi-passenger van. This service ensures that all qualifying Veterans who do not have access to transportation options of their own, due to financial, medical, or other reasons, are able to travel to VA medical facilities or authorized non-VA appointments to receive the care they have earned.

AIDS United: Southern REACH
Southern REACH (Regional Expansion of Access and Capacity to Address HIV/AIDS), a special initiative of AIDS United, aims to address the disproportionate impact of HIV/AIDS in the U.S. South (Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Texas, and Virginia). This round of the Southern REACH initiative will focus on the integration of an intersectional social justice approach to HIV advocacy. Priority will be given to community-based organizations and coalitions with demonstrated access to key populations and a history of community engagement and mobilization. This year, civil rights and social justice groups without a previous history of HIV advocacy are eligible to apply. Through this RFP, AIDS United will provide a combination of cash grants of up to $100,000 and technical assistance.
The application deadline is October 7, 2016.

Accountable Health Communities: Track 1 – Awareness
This funding opportunity announcement is for the Track 1 – Awareness track only and includes the following elements: (1) screening of community-dwelling beneficiaries to identify certain unmet health-related social needs and (2) referral of community-dwelling beneficiaries to increase awareness of community services.
Application Deadline: Nov 3, 2016

Farm to School Grant Program
Grants to plan, establish, or sustain a Farm to School program that improves access to local foods in schools.
Application Deadline: Dec 8, 2016

School Garden Grant
Program provides a $2,000 monetary grant to support an edible educational garden on the grounds of a K-12 school. Schools, or a non-profit organization working in partnership with a school, may apply.
Deadline: October 31

Sodexo Stop Hunger Foundation: Stephen J. Brady STOP Hunger Scholarships
The Stephen J. Brady STOP Hunger Scholarships, funded by the Sodexo Stop Hunger Foundation, recognize students who are driving awareness and mobilizing youth to be catalysts for innovative models and solutions to eliminate hunger in America. Applicants must have demonstrated ongoing commitment to their community by performing unpaid volunteer services impacting hunger in the United States within the last 12 months. Additional consideration is given to students working to fight childhood hunger. Students between the ages of five and 25 are eligible to apply. The winners receive a $5,000 scholarship, as well as a $5,000 grant made in their name to the hunger-related charity of their choice in their local community. In addition, regional honorees receive a $1,000 grant made in their name to the hunger-related charity of their choice.
Applications may be submitted online from October 5 through December 5, 2016.